Alternative surgical strategy for the treatment of a mycotic aortic arch aneurysm

We report the case of a 69-year-old man who presented with a symptomatic mycotic aneurysm of the aortic arch. Diagnosis was confirmed by positron emission tomography and by blood cultures positive for Salmonella species. A complete resection of the aortic arch process was performed via left thoracotomy using a cryopreserved aortic homograft and normothermic left heart bypass. The left-sided cerebral vessels were clamped, and adequacy of collateral left brain flow and oxygenation was confirmed by neurophysiologic monitoring. Using this less-invasive operative strategy, we avoided the risks inherent to deep hypothermic circulatory arrest and the use of prosthetic materials.